The New York State Department of Health (NYSDOH, the applicant) has developed a comprehensive system for its Adult Day Health Care Program (ADHC). Building on this system the proposed project will (a) use taxometric analysis to develop behavioral typologies of subgroups among current clients of ADHC programs, and (b) based on this analysis and on input from several other sources including an Advisory Committee, will further develop and target program and community-based specific interventions to each subgroup. With rare consistency studies have shown adult health related daycare to be relatively ineffective in terms of preventing or substantially postponing long term institutional placement. As Holmes (the proposed Senior Scientist) has pointed out, this seeming lack of success in part may be attributed to failure to identify subgroups among the daycare population with consequent tailoring of program elements to identifiably different needs. Further, such a focus on reducing institutional placement overlooks a more fundamental issue: enhancing -- or making less noxious -- the lives of elderly persons with dementing illness and those charged with their community-based care. Dr. Koren (the proposed principal investigator) has been particularly concerned about quality of life issues, and has implemented a state-wide non-resistant use policy in long-term care facilities. Although the focus of the study will be on Adult Day Health Centers, inclusion of Alzheimer's Association staff on the Advisory Committee will ensure that resulting products are equally suitable for use by family caregivers and others not necessarily in a group or program setting. The hypotheses to be tested is: Among clients with mild to moderate cognitive impairment enrolled in Adult Day Health Care Programs, there are identifiable subgroups in terms of patterns of disturbing behaviors exhibited. Differential intervention strategies will be logically associated with each of these behavioral subgroups. An implicit project goal is to augment, permanently, all measures used by the applicant to collected ADHC information which adequately represents key behavioral domains.